Occupational Therapy in Early Intervention
Occupational therapists play an important role at P.G. Chambers School by providing services to children in our school, early intervention, and community services programs. Our team of occupational therapists design individualized therapy sessions to meet each child’s developmental and academic goals. In celebration of Occupational Therapy Month, we invite you to learn more about our incredible OTs and what they do!
Occupational Therapy in Early Intervention[This blog was written before the implementation of telehealth therapy services. Though the therapist is not currently working in the children’s homes, the principles remain the same.]
By Linda Hogoboom, MS, OTR/L
Occupational therapy is not as hard to define as many believe; it is all about function. It is about expanding and enriching how a child spends their time, or how they are occupied. Each child can be quirky and unique – that’s called personality! Making sure that each child can also be occupied in play, self-care, and social routines with the family is where we can help.
Occupational therapy (OT) can focus on building strength and physical skills so that a child’s posture can support the use of their hands in fine motor activities to grasp and release objects in a refined and successful way. OT can focus on visual motor integration so that a child can smoothly coordinate to draw a circle, place a puzzle piece, tower a block, or string a bead. OT can focus on tolerating and participating in ‘activities of daily living’: diaper changes, bath time, mealtime, and bedtime routines. Finally, OT can expand a child’s sensory integration skills, how they use the information that they take in from all the sensations around them. These sensations are familiar ones like sight, smell, hearing, taste, and touch, and also include vestibular sensations (our relationship with gravity and movement), proprioceptive (where the body is positioned in space), and tactile (which includes perception of size and shape of objects touching the body). Some children are overwhelmed by these sensations and retreat from activities or social interactions. Other children are not sufficiently aware of these sensations, and therefore cannot use them to guide their interactions with toys or people. Most frequently, the child shows a combination of reactions to sensory input depending on what information they are receiving (i.e. more reactive to sound but less reactive to movement input).
In Early Intervention, we have an advantage that other settings do not since we have the most knowledgeable and motivated team members: the families and caregivers. We work directly in the home or daycare and are able to see and work first-hand in the environment where a child spends all their time learning new skills. In this way, we can carefully match the structure of treatment sessions and carry-over recommendations to the style of each individual family (and sometimes even each caregiver within that family). At different points the focus of our sessions may be more about strengthening the child’s muscles, or developing self-feeding skills, or developing tolerance for an adult leading and changing routines – always while building play skills, which is the main occupation of our kids. One approach does not fit all kids. Even if you have the best and most research-based approach, it may not be right for a certain child or family.
The essentials of OT are task analysis and gradation of activities. Let’s look at one example of how occupational therapy in early intervention might approach a common activity: putting pieces in a puzzle. For some children, we might start with the motor action and strengthening the muscles needed to sit up on their own, then focus on arm and hand muscles so that they can reach and play comfortably. We can work on simply being able to sit up, pick up that piece and then let it go. The next step is to combine that with a direction and a social interaction – asking the child to ‘give’ you the puzzle piece by placing it in your hand or dropping it in a container. Then we refine the task by having them release toys more precisely – from dropping into a big bowl, to dropping into a smaller opening like a cup, to orienting a large coin into a slot. Other children may need us to start with engaging them or drawing their attention socially so that they become interested in following our lead. We need the family to help us learn what is most interesting to that child and then mix that into the activity or skill we want to expand (putting letters on the blocks we want them to build with, or using the beloved baby doll to give a pretend bath and encourage water play). If the child is not interested in puzzles at all but loves sensory materials, we might hide the puzzle piece in a piece of dough or wrap it in a piece of painter’s tape and then ask the child to pull the piece out and then place it, rewarding them with the next piece wrapped in sensory material. If they are a child that is often ‘on the move’, we can structure that movement to increase their engagement in the puzzle activity by moving in/out of a tunnel or up/down from the couch to get the puzzle pieces. We can use visual cues like a solid colored towel on the carpet or a small lap table to sit on/come back to during play. Maybe that child just loves to throw the pieces, so we might give them a clear target, such as a big basket, for their throws. For the child who loves the visual input they get when they throw the puzzle piece or when they hold the piece close to their eyes and spin it, we might start with movement activities on a therapy ball or with visual input that includes starts and stops. We always use cues such as “ready/set/go” which give the child time to prepare for the input that we will give and we use simple and consistent language, coupled with visual cues or gestures to build communication skills and the motor skills for them to be successful. The key always seems to be finding what the child likes and following their lead, encouraging social experiences during play, and then expanding their motor skills with a ‘just right’ challenge.
Occupational therapy helps children engage in the activities that occupy them, whether that is participating in the classroom, playing, or completing a task at home. The outcome is that the child can take the experience they had in play and the caregiver can take the strategies we used in play, and apply them to the various activities in their lives, such as sitting to read a book together, learning to get dressed, sitting for a meal, or transitioning to the car to go shopping. Occupational therapists know how to get important results from play!